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Utah rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $2.70 / $2.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.70 / $5.26 / $28.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $6.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.93 / $11.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.91 / $7.21 / $9.39
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $6.91 / $10.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.20 / $4.19 / $4.91